Don’t forget the real pain behind the opioid crisis
I have good news and bad news. Good news is today, jobs are plentiful in most parts of the country. Bad news is many working age adults cannot qualify for them because of opioid use and abuse.
The current opioid crisis is real and getting worse. From 1999 to 2016, according to the federal Centers for Disease Control and Prevention, more than 630,000 people died from a drug overdose. In 2016, 66 percent of the more than 63,600 drug overdose deaths involved an opioid, a drug that acts on the nervous system to relieve pain.
A bright spot in the otherwise bleak opioid landscape is that awareness of the personal, social and economic costs of opioid abuse is rising. In addition, public and private efforts are
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gathering momentum to control this manmade epidemic.
In Memphis, local governments have collaborated with nonprofit and educational institutions to become organized in formulating and implementing educational and treatment strategies.
Nationally, professional organizations such as the American Medical Association and the Joint Commission have issued new guidelines for the proper management of pain and the prescription of opioids in both physician offices and the hospitals.
For longer-term results, medical schools across the country have begun to teach the next generation of physicians, dentists and pharmacists about both the benefits of pain medications and the potential abuse of them.
Similar to the success of tobacco control, we will eventually overcome the opioid addiction problem with concerted efforts, commitment, and resources.
However, controlling opioid addiction is not the same as correcting nicotine addiction. Failure to understand the differences will result in solving one problem by creating another.
It’s best to start by looking at the recent history of the opioid crisis. A complex set of supply and demand factors are responsible for today’s opioid crisis that caused 42,000 deaths in 2016.
On the demand side, researchers Dr. Hershel Jick of the Boston University Medical Center and his assistant Jane Porter published a much misunderstood letter in the authoritative New England Journal of Medicine in January 1980.
They reported that despite common use of narcotics in hospitals, addiction was rare for patients with no history of
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addiction. Many more research studies by other researchers soon followed pushing back the belief that using opioid to treat chronic pain was risky.
With growing evidence assuring the safety of prescription opioids, Dr. Mitchell Max, the President of the American Pain Society, wrote in 1990 an editorial in the influential medical science journal, the Annals of Internal Medicine, alerting to the lack of improvement in pain assessment and treatment in the United States.
Six years later, in 1996, the American Pain Society officially designated pain as the fifth “vital sign” that doctors were urged to watch when seeing patients.
In 2001, the Joint Commission, the powerful nonprofit organizations that accredits more than 21,000 U.S. health care organizations and programs published its Pain Management Standards, which required healthcare providers to ask every patient about his or her pain.
On the supply side, pharmaceutical companies invested heavily in the 1980’s and 1990’s to bring new opioids to the market and aggressively market them to prescribers and their patients.
During the same period, more Americans gained health insurance coverage and insurance companies and health plans increasingly added drug benefits to what they covered as health plan sponsors such as large and government employers became more generous in offering employee benefits.
The supply of newer and more powerful prescription opioids and the increased demand for them created a medical perfect storm.
Like tobacco, many opioids are extremely addictive. Unlike tobacco, however, prescription opioids offer definite medical benefits in terms of their efficacy in relieving chronic pain and pain-related symptoms. Thus not all the strategies and lessons learned from tobacco control can be applied to opioid control without modification.
For example, there is little downside to the efforts for tobacco control with the exception of the loss of tobacco tax revenues. In contrast, overly aggressive anti-opioid campaigns such as threatening prescribers with legal actions or a wholesale ban of the use of prescription opioids and other control substances can result in an overcorrection of the problem and undertreated chronic pain.
With the country embarking on a new national campaign to stem the tide of opioid abuse, we need to be mindful that our eagerness and determination to stop the crisis may end up swinging the proverbial pendulum too far to the other side.
To avoid such an extreme, we should encourage pharmaceutical companies to come up with drugs that work with tolerable side effects, and allow doctors and other providers to prescribe opioids for treating pain without fear of harming their patients or legal consequences.
Pain is a real medical problem and a legitimate vital sign for providers to monitor and treat.
Cyril F. Chang is a Professor of Economics at the Fogelman College of Business and Economics, the University of Memphis. The views expressed here are solely his and they do not necessarily represent those of his employer.